Medicare Developing Direct Pay Model For Seniors, Primary Physicians

April 25, 2018

Medicare ( The Centers For Medicare and Medicaid Services) announced it is exploring a direct-provider payment model for seniors. The beneficiary will be primary care physicians.

This program would directly pay primary care physicians and multi-specialty group practices that provide services to Medicare Advantage and Medicaid beneficiaries. It replaces the existing fee schedule with fixed, lump-sum payments.

Medicare: Proposals Cut Out Red Tape, Helps Seniors

They also proposed additional payment changes for hospitals and long-term care facilities. These include pricing transparency and access to their electronic medical records.

AARP has already come out against the direct-contractor proposal, telling Modern Healthcare that private contracting would allow doctors to pick and choose patients and services.

They claim that current policies are working fine. Current rules prevent doctors from choosing patients based on the severity of their illness or charging different patients different amounts. Moreover, fraudulent billing is reduced ands are protected from high out of pocket costs.